Characteristics of Patients Hospitalized with 2009 H1N1 Influenza in a Tertiary Care Hospital in Southern Saudi Arabia.

BACKGROUND: Pandemic influenza A (H1N1) virus emerged and spread globally in the spring of 2009. We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia. We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome. METHODS: We performed a prospective study in all patients who were hospitalized for at least 48 hours and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction). Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death) was observed. We applied a logistic regression analysis to determine the best predictor of death. RESULTS: A total of 52 patients (15 males) were adults and 65 were pediatrics (< 12 years of age) (19 males). The common presenting signs and/or symptoms associated with the disease was fever >38.5 ºC (n=85; 72.6%), dry cough (n=81; 69.2%), dyspnea (n=40; 34.5%), tachycardia (n=96; 83.5%) and saturation less than 90% in room air on pulse oximetry (n=65; 55.6%). The complications included pneumonia (40.2 %), intensive care unit admission (19.2%) and death (16.7%). CONCLUSIONS: We found that hypoxia at admission was the most important predictive factor of poor outcome (death) with area under curve of 0.768.

A case report of pseudo-subarachnoid hemorrhage.

BACKGROUND: The authors report an unusual case of the radiological appearance of diffuse subarachnoid hemorrhage on brain computed tomographic (CT) scan in a patient with post-resuscitation anoxic encephalopathy. CLINICAL PRESENTATION: A young man with chronic renal failure collapsed unconscious while starting hemodialysis and was revived after resuscitation for almost one hour. He was shifted to intensive care unit and subsequent CT scan after 3 days showed a picture compatible with diffuse subarachnoid hemorrhage. The subsequent lumbar puncture showed no evidence of subarchnoid hemorrhage while the attenuation at the basal cistern on CT brain was consistent with pseudosubarachnoid hemorrhage. A four vessel angiography done subsequently confirmed anoxic encephalopathy. CONCLUSION: Anoxic encephalopathy can mimic diffuse subarachnoid hemorrhage on CT.

Can Behcet's Disease Related Pulmonary Arterial Aneurysms be Completely Resolved?

Behçet disease is a systemic disease with diverse clinical symptoms which include, but not limited to, patients having oral and genital ulcers and eye involvement. We here report an 18-year-old male presenting with massive hemoptysis and cardiac arrest, having history of ulcers in the oral cavity and genitalia as well as having recent episode of uveitis. A pulmonary CT angiography revealed bilateral arterial aneurysms of pulmonary vessels. On receiving Immunosuppressive treatment for Behcet disease with prednisone and azathioprine over one year the pulmonary arterial aneurysms were completely resolved and the patient was discharged from the hospital albeit with persistent hypoxic brain injury from cardiac arrest.

Major artery occlusion: a rare complication of sickle cell disease.

Sickle cell disease is hereditary hemoglobinopathy which causes haemolytic anemia, vaso-occlusive crisis, ischemic injuries and many other morbidities like cerebral infarction. In this report, we describe a case of a young patient with sickle cell disease presenting with right-sided weakness and slurring of speech with examination confirming right-sided hemiparesis with motor aphasia. On further investigation, she was found to have frontotemporal infarction. On magnetic resonance imaging with angiography, she was found to have absent circulation in left internal carotid artery probably secondary to sickle cell disease. Major vessel occlusion is rare complication of sickle cell disease that one must bear in mind.